The Shoulder Symptom Modification Procedure (SSMP): A Reliability Study
Hilla Sarig Bahat* and Orna Kerner
Department of Physical Therapy,University of Haifa, Israel.
- *Corresponding Author:
- Hilla Sarig Bahat
Lecturer, University of Haifa
Physical Therapy, Mt. Carmel
Tel: +972545380483, +972773506060
E-mail: [email protected] o l
Received Date: May 16, 2016; Accepted Date: July 26, 2016; Published Date: August 08, 2016
Citation: Sarig Bahat H, Kerner O (2016) The Shoulder Symptom Modification Procedure (SSMP): A Reliability Study. J Nov Physiother S3:011. doi: 10.4172/2165-7025. S3-011
Copyright: © 2016 Sarig Bahat H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Study design: Cross section reliability study. The study assessed inter-tester (n=90) and intra-tester reliability (n=25) of the Shoulder Symptom Modification Procedure (SSMP) in adults with localized shoulder pain. Objective: To evaluate the inter- and intra-tester reliability of the SSMP for shoulder assessment in patients with shoulder pain. Background: Diagnosing the underlying structures responsible for shoulder symptoms is difficult and commonly does not advance treatment. Current orthopedic assessment techniques are mostly provocative, and do not necessarily direct towards an effective strategy. The SSMP was developed to provide a treatment-oriented assessment. Methods: Patients underwent an initial functional test used as a reference for their shoulder symptoms. The SSMP aimed to find a technique that eases these symptoms. It comprised four modification categories: Thoracic kyphosis, scapular position, humeral head position, and neuro-modulation. Each modification resulted as positive if symptoms improved more than 30%. Inter-tester reliability was assessed by comparing findings by 2 physiotherapists (arranged in 3 pairs of 3 blinded testers). Intra-tester reliability evaluation included repeated testing by one physiotherapist. A washout period of 20-40 minutes was allowed in between repeated tests, during which intra-tester assessed/treated others and patients rested. Cohen’s kappa was used for statistical analysis. Results: Inter-tester reliability showed moderate to almost perfect agreement in the thoracic kyphosis and humeral head position categories (ÐÂ=0.77, 0.86 and ÐÂ=0.78, ÐÂ=0.74 respectively). Intra-tester reliability showed moderate agreement in the humeral head category (ÐÂ=0.66). Other categories showed poor to moderate agreement. Conclusion: Findings showed overall moderate reliability, with good reliability achieved for thoracic and humeral head modifications alone. Reliability was possibly limited due to the changeable nature of the variable being assessed. Symptom intensity may have changed due to modifications, altering the response to the provocation in the second test. Further research should investigate whether higher reliability can be achieved with procedures addressing the limitations identified.